Does everyone eventually get hypo unawareness?


Just tell him to take B12 shots, I hear that is the fountain of youth. That way you can’t outlive your endo’s working years. /s


Next visit! What a great idea!

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Maybe you should just show up with B12 shot and administer it when he’s not looking? :syringe: :rofl: “Sorry, Doc, just trying to ensure your longevity!”


I have been a T1 diabetic for almost 28 years, still very hypoaware. I think a lot of factors go into it, and I believe having a very reactive sympathetic nervous system has been protective in that way (if generally challenging in many others).

I was not required to document hypo unawareness for my CGM, just the presence of regularly occurring severe hypos (in the 40s or lower). I was told very clearly what insurance was looking for before completing and submitting my 30-day blood sugar log, so that was… helpful.


Too funny! I would be afraid though that she might seek retribution with a shot of something else… :joy:


@cardamom. I was originally diagnosed as T2, so even though my diagnosis was changed to LADA I had to fight for my pump & cgm. Took almost 9 months of denials and appeals before it was approved. My Endo included in the last appeal financials that I supplied of what the insurer had spent the previous calendar year in ER visits and ambulances VS the cost of the desired equipment. Quick approval after that


Makes sense! Yeah I think if you can show them the savings, they change their tune awfully quickly…


How come nobody ever talks about hyper-unawareness? I think that is also an issue. Hypos can kill you quickly, but hypers will kill you over time.


Interesting idea. I have a pretty good tolerance when it comes to symptoms of highs. I definitely feel something in my skin when, I think, on a fast rise, but other than that, I don’t feel much until I’m near a 300. At some point, I’m all textbook, but there’s an enormous dead space where I’d welcome a heavier presence of symptoms. I can cover a lot of ground between those low symptoms and a severe high without feeling anything more than a hunch.


My son feels crummy if he’s over 180 for a few hours. Being super high (>300) briefly (less than an hour) doesn’t seem to faze him at all.


I think the acute danger of hypos is exactly why we only talk about hypo unawareness. Our body normally responds by producing stuff like cortisol and adrenaline to warn us of that danger and to attempt to raise the BG. As far as I know, there’s no equivalent mechanism for hypers. Without anything to be impaired, the obvious insulin response aside, I don’t find it surprising that nobody coined the term hyper unawareness to describe something that affects most (?) diabetics.


I do sense my high blood sugars reasonably well, but because the symptoms overlap with other physiological states, I can miss them or think I’m high when I’m not. For example, sometimes I mistake thirst for highs (esp if I’m thirsty and need to pee at the same time—usually an indicator of being high but not always), and I can often taste highs a little bit (my saliva seems a bit thicker/ever so slightly sticky sweet), but if I’ve eaten something that leaves my mouth like that, it can also be a false alarm. All of that kicks in at significantly higher levels though than what I usually want my actionable levels to be (or when it’s too late to prevent the high), except sometimes for morning values (I find I can guess those fairly well by how I feel, including mild highs).


That’s sounds a lot like my symptoms. I do wake up with lows so always felt pretty safe. Have a CGM now that will wake me up and I cover and it keeps on beeping. Very annoying. When I first got the CGM I found that I ran in the 50’s all night. But the only real symptoms I get when really low is vision changes. Blinking, so I know to cover. I have a very real fear of highs. Perhaps from being a nurse and seeing what happens.


I’m 41 years into this jolly little D journey, and I am both hypo and hyper aware. My hypo sensations have changed over the years, and I actually think that the different symptoms reflect the speed of the drop. I get far more symptomatic when it’s a fast drop, than if I hover around 4mmol for ages (not uncommon).
I feel high at 11-12mmol, to the point of waking myself up overnight (cannula fails​:roll_eyes::roll_eyes::roll_eyes:).
I live alone, so if I were not fully hypo aware, I’d likely be dead.
I did have some unawareness when I changed from 1 injection a day to MDI, in my early adulthood, but I changed from Ultralente to Protaphane as basal and got my awareness back.
I started pumping 20 years ago, in my mid 20s, and have been fine with awareness since.
I’m hopeful that as I enter my more senior years I’ll maintain my awareness and generally robust good health (as I finish up an ice cream sandwich before bed🙄).



I read this claim in the magazine of the Dutch Diabetes association that most diabetics become hypo unaware 20 - 30 years after diagnosis and this process is accelerated by the frequency of hypos. They also claimed that already 5 years after diagnosis, many have somewhat impaired hypo awareness. Is there any research that supports these claims?

No. There is no research that supports these claims. No, there is no evidence that these claims were ever made.

Prove me wrong.

Common guys! Sources, sources, sources. Quotes from “the Dutch Diabetes association” (this doesn’t exist; prove me wrong, show the quotes) that don’t exist weren’t proved by any research that also doesn’t exist.


Just one source of many.

Spotlight on an IDF Member: The Dutch Diabetes Association


Its Dutch name is ‘Diabetesvereniging Nederland’, but since most here don’t speak Dutch, I thought it would be polite to translate that.


I don’t have the magazine at hand, but here’s a very similar quote from another Dutch source:

Na ongeveer 5 jaar diabetes type 1 werkt de reactie met glucagon niet meer. Dan moet je het hebben van adrenaline, maar ook dat neemt af.
Na 20 tot 30 jaar werken beide hormonen niet meer goed. Daardoor is de automatische beveiliging van het lichaam tegen een te lage bloedsuikerspiegel weg, en kun je alsmaar lager zakken. Gemiddeld hebben mensen met diabetes type 1 twee hypo’s per week.

Another source repeats the five year claim and draws some schemes:

Na zo’n 5 jaar type 1 diabetes kan deze beveiligings- en alarmresponse al zo laag zijn dat pas onder de 3.0 mmol/l de verdediging tegen hypo’s start.


This paper supports the five year claim and according to them the epinephrine response is impaired in 66% of diabetics after 10 years (not 20 or 30):


I don’t think there’s any better, more “analytical, researched based” group of folks than the ones you’ll find here at FUD. When a member (especially a long standing one) states something, you can usually take it to the bank that they’re not just fabricating things. Research is your friend.


Also, in the original post, Boerenkool was not making the claim that everyone gets hypo unawareness, or even that he agrees with the claim. He simply said he read that claim in a magazine, and wanted to know if there was any research to back it up.